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- Title
Improving Emergency Department radiology transportation time: a successful implementation of lean methodology.
- Authors
Hitti, Eveline A.; El-Eid, Ghada R.; Tamim, Hani; Saleh, Rana; Saliba, Miriam; Naffaa, Lena
- Abstract
<bold>Background: </bold>Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography.<bold>Methods: </bold>We performed a before and after study at an academic urban Emergency Department with 49,000 annual visits after implementing a Lean driven intervention. The primary outcome was mean radiology transportation turnaround time (TAT). Secondary outcomes included overall study turnaround time from order processing to preliminary report time as well as ED length of stay. All ED patients undergoing plain radiography 6 months pre-intervention were compared to all ED patients undergoing plain radiography 6 months post-intervention after a 1 month washout period.<bold>Results: </bold>Post intervention there was a statistically significant decrease in the mean transportation TAT (mean ± SD: 9.87 min ± 15.05 versus 22.89 min ± 22.05, respectively, p-value <0.0001). In addition, it was found that 71.6% of patients in the post-intervention had transportation TAT ≤ 10 min, as compared to 32.3% in the pre-intervention period, p-value <0.0001, with narrower interquartile ranges in the post-intervention period. Similarly, the "study processing to preliminary report time" and the length of stay were lower in the post-intervention as compared to the pre-intervention, (52.50 min ± 35.43 versus 54.04 min ± 34.72, p-value = 0.02 and 3.65 h ± 5.17 versus 4.57 h ± 10.43, p < 0.0001, respectively), in spite of an increase in the time it took to elease a preliminary report in the post-intervention period.<bold>Conclusion: </bold>Using Lean change management techniques can be effective in reducing transportation time to plain radiography in the Emergency Department as well as improving process reliability.
- Subjects
EMERGENCY medical services; RADIOLOGY; HOSPITAL overcrowding; HOSPITAL care; HEALTH outcome assessment; QUALITY assurance standards; MEDICAL care standards; CROWDS; LENGTH of stay in hospitals; HOSPITAL emergency services; HOSPITAL radiological services; MANAGEMENT; MEDICAL care; ORGANIZATIONAL effectiveness; PATIENTS; RESEARCH evaluation
- Publication
BMC Health Services Research, 2017, Vol 17, Issue 1, p1
- ISSN
1472-6963
- Publication type
journal article
- DOI
10.1186/s12913-017-2488-5